Government initiatives called for electronic health records for each individual healthcare consumer by 2014. the purpose of the initiatives is to provide for the common exchange of clinical information between healthcare consumers, healthcare providers, third-party payers and public healthcare officials.This exchange of healthcare information will impact the healthcare industry and enable more effective and efficient application of healthcare so that there may be a decrease in medical errors, increase in access to quality of care tools, and enhancement of decision making abilities by healthcare consumers, healthcare providers and government health agencies. an electronic personal health record (ePHR) created, managed and accessed by healthcare consumers may be the answer to fulfilling the national initiative. However, since healthcare consumers potentially are in control of their own ePHR, the healthcare consumer’s concern for privacy may be a barrier for the effective implementation of a nationwide network of ePHR. a technology acceptance model, an information boundary theory model and a trust model were integrated to analyze usage intentions of healthcare consumers of ePHR. Results indicate that healthcare consumers feel there is a perceived usefulness of ePHR; however they may not see ePHR as easy to use. Results also indicate that the perceived usefulness of utilizing ePHR does not overcome the low perceived ease of use to the extent that healthcare consumers intend to utilize ePHR. in addition, healthcare consumers may not understand the different components of usage: access, management, sharing and facilitating third-party ePHR. Also, demographics, computer self-efficacy, personal innovativeness, healthcare need and healthcare literacy impact a healthcare consumer’s privacy concerns and trusting intentions in the context of ePHR and intent to utilize ePHR. Finally, this research indicates that healthcare consumers may need a better understanding of the Health Insurance and Portability and Accountability Act of 1996 (HIPAA) regulations of ePHR as well as a better understanding of the impact HIPAA has on websites that may facilitate ePHR.

This dissertation is organized in a traditional format while including three essays that address specific research questions. Essay 1 examined the relationship between physical activity and community engagement and their effect on mental well-being among older men and women. Data from National Health and Aging Trends Study (NHATS) from 2018 to 2020 were explored and the posited relationships were tested. This essay provides empirical support that older adults who are reasonably active and involved in the community have greater mental well-being than those who isolate themselves. Essay 2 provides insight into older adults' motivation to improve their physical activity through the use of a fitness tracker. The key finding from this study is that wearables, especially fitness trackers, can significantly facilitate increased physical activity. Essay 3 is a mixed-methods study to understand older adults' perception of the usefulness of fitness trackers and interaction with such devices. Findings suggest that to increase the adoption of fitness trackers among older adults, makers could improve the esthetics and quality of the wristband in addition to the battery life of the tracker.

Indiana University-Purdue University Indianapolis (IUPUI) / Health IT has recently seen a significant progress with the nationwide migration of several hospitals from legacy patient records to standardized Electronic Health Record (EHR) and the establishment of various Health Information Exchanges that facilitate access to patient health data across multiple networks. While this progress is a major enabler of improved health care services, it is unable to deliver the continuum of the patient's current and historical health data needed by emerging trends in medicine. Fields such as precision and preventive medicine require longitudinal health data in addition to complementary data such as social, demographic and family history. This thesis introduces a person health record (PHR) which overcomes the above gap through a personalized framework that organizes health data according to the patient’s disease condition. The proposed personalized person health record (P2HR) represents a departure from the standardized one-size-fits-all model of currently available PHRs. It also relies on a hybrid peer-to-peer model to facilitate patient provider communication. One of the core challenges of the proposed framework is the mapping between the event-based data model used by current EHRs and PHRs and the proposed condition-based data model. Effectively mapping symptoms and measurements to disease conditions is challenging given that each symptom or measurement may be associated with multiple disease conditions. To alleviate these problems the proposed framework allows users and their health care providers to establish the relationships between events and disease conditions on a case-by-case basis. This organization provides both the patient and the provider with a better view of each disease condition and its progression.

Problem statement: As a result of the aging population, the number of people living with chronic disease has increased to almost 50% (CDC, 2004). Two of the main goals in treating patients with chronic diseases are to provide seamless care from setting to setting and prevent disability in the older adult. Many have proposed the use of electronic personal health record systems (PHRs) in the self-management process, but adoption remains low. The purpose of this research was to validate and test an explanatory model of the barriers and facilitators to older adults' adoption of personal health records for self-managing chronic illnesses. The long range goal of the research is to use the explanatory model to develop interventions that will maximize the facilitators and minimize the barriers to adoption. Methods: A preliminary attempt to capture the essential barriers and facilitators that predict adoption of PHRs among older adults with chronic illness was synthesized from the literature. In Phase One of the study, the model was integrated from existing literature and validated using a Delphi method. In Phase Two of the study, the model was pilot tested and refined for future investigations. Findings: The results of this study validated the Personal Health Records Adoption Model (PHRAM) and a preliminary instrument that measured barriers and facilitators to the adoption of PHRs in older adults who are self managing chronic illness. Additional findings indicate that while seniors are seeking options to manage their health and have expressed an interest in using Internet-based PHRs, they may require assistance to gain access to PHRs. Implications: The potential for PHRs to increase patient autonomy and reduce for disability and the resulting negative health consequences needs further investigation as we move into the next era of healthcare delivery. The results of this study provided the foundation for continued theoretically-based research in this area.

Patient engagement is one of the 6 quality directives issued by the Institute of Medicine for patient-centered care. Federal meaningful use regulations require health care organizations to offer patients a secure online website, or patient portal, to access their health information. Although the patient portal offers patients the opportunity to be more involved in their care, the portal has not been widely used. However, barriers to utilization are best understood from the perspective of the patient. Any barriers to patients accessing the portal are also barriers to patient engagement. The purpose of this project was to understand from the patient perspective why 99% were not using the portal at a large health system. The goal was to understand the patient preferences and their expectations for the portal as well as the perceived barriers. The Diffusion of Innovation Theory guided this quality improvement project to understand the patient perspective to initiate focused portal revisions and program changes. A focus group method was used to interview patients about their portal knowledge, willingness to use the portal, and general preferences for accessing health information. Four focus groups were conducted with 15 participants. Each session was recorded, transcribed within the program NVivo, and reviewed through content analysis. The main barrier to patient portal use is a general knowledge deficit about the purpose, usefulness, and accessibility. As possible solutions, the participants suggested education and promotion materials are essential. Also, nursing staff will need to offer patients information about how to access and use the portal. Through this project, positive social change can be achieved as patients will have better access to their personal health information with the revised portal.

There is a growing demand to involve patients in their own healthcare. Personal Health Records are among the most promising tools for this purpose. However, these tools need to meet patients’ needs and interests in order to be fully adopted and successfully used. This study takes a user centered design approach to design and develop a personal health record for prostate cancer patients by involving them in two main activities of a user centered design: requirements gathering and evaluation. The first phase of the study uses content analysis to analyze interviews with patients and elicit their needs and concerns. Results of this phase showed that patient’s information needs are different depending on the stage of the disease. Before starting treatment, patients are more interested in information about different methods of treatment and their potential side effects. However, after treatment, patients mostly need information about the management of treatment complications and the long term follow ups of their disease. Results also showed that the Internet is the most common information source for patients to find information. However, patients expressed concerns regarding the credibility and reliability of information they found on the Internet. The majority of patients also showed interest in accessing their medical records. However, some patients were concerned about the understandability of the information. Also, there was some concern regarding electronic access to medical records and security of personal data. The findings from phase one are used in phase two to modify a preliminary prototype of the system. In phase three, the modified prototype is evaluated by undergoing usability testing. Overall, the results of usability testing showed that the system was generally useful and easy to use. However, a number of issues were identified that could be resolved in the next iteration of its design and development. / Graduate / 0984

Thesis (M.S.)--University of Wisconsin--Madison, 1982. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 88-101).

abstract: A long tradition of adoption of innovations research in the information systems context suggests that innovative information systems are typically adopted by the largest companies, with the most slack resources and the most management support within competitive markets. Additionally, five behavioral characteristics (relative advantage, compatibility, observability, trialability, and complexity) are typically associated with demand-side adoption. Recent market trends suggest, though, that additional influences and contingencies may also be having a significant impact on adoption of innovative information systems--on both the supply and demand-sides. The primary objective of this dissertation is to extend our theoretical knowledge into a context where consumer influence is a key consideration. Specifically, this dissertation focuses on the Personal Health Record (PHR) and patient portal market due to its unique position as a mediator between supply (ambulatory care clinic) and demand-side (patient and health consumer) interests. Four studies are presented in this dissertation and include: 1) an econometric examination of the contingencies associated with supply-side (ambulatory care clinic) adoption of patient portals, 2) a behavioral assessment of patient PHR adoption intentions, 3) an integrated latent variable and discrete choice evaluation of consumer business model preferences for digital services (PHRs), and 4) an experimental evaluation of how digital service (patient portal) feature preferences are impacted by assimilation and contrast effects. The primary contribution of this dissertation is that adoption (and adoption intentions) of consumer information systems are significantly impacted by: 1) supply-side adoption contingencies (even when controlling for dominant-paradigm adoption of innovation characteristics), and 2) demand-side consumer preferences for business models and features in the context of assimilation-contrast (even when controlling for individual differences). Overall, this dissertation contributes a new understanding of how contingent factors, consumer perceived value, and assimilation/contrast of features are impacting adoption of consumer information systems / Dissertation/Thesis / Ph.D. Information Management 2012

Doctor of Philosophy / Department of Psychology / Ronald G. Downey / Work engagement has received increased attention by both practitioners and academicians. Researchers and practitioners have focused on the antecedents of employee engagement and the positive outcomes of an employee being engaged. This study served to expand the literature on antecedents and outcomes of work engagement to include human resources practices, such as Realistic Job Previews (RJP) and selection tests, as antecedents. A sample of 161 Information Technology help desk support representatives, who were grouped by receiving or not receiving an RJP and a selection test, were assessed on the Utrecht Work Engagement Scale (Schaufeli, Salanova, Gonzalez-Roma, and Bakker, 2002). Significant differences were found for individuals who recalled receiving an RJP on work engagement. Significant differences were not found for the selection test group on work engagement. Additional analyses were conducted to determine the predictability of engagement on individual (e.g., personal health and job satisfaction) and organizational outcomes (e.g., turnover intentions and performance). Overall, results suggest that human resources practices should be included in the work engagement model. Additional research directions and organizational implications were discussed.

Indiana University-Purdue University Indianapolis (IUPUI) / Patients and providers need to exchange medical records. Electronic Health Records and Health Information Exchanges leave a patient’s health record fragmented and controlled by the provider. This thesis proposes a Peer-to-Peer Personal Health Record network that can be extended with third-party services. This design enables patient control of health records and the tracing of exchanges. Additionally, as a demonstration of the functionality of a potential third-party, a Hypertension Predictor is developed using MEPS data and deployed as a service in the proposed framework.